March 26th, 2020
Epidemiologist Behind Highly-Cited Coronavirus Model Drastically Downgrades Projection
By Amanda PrestigiacomoDailyWire.com
Epidemiologist Neil Ferguson, who created the highly-cited Imperial College London coronavirus model, which has been cited by organizations like The New York Times and has been instrumental in governmental policy decision-making, offered a massively downgraded projection of the potential death toll on Wednesday.
Ferguson’s model projected 2.2 million dead people in the United States and 500,000 in the U.K. from COVID-19 if no action were taken to slow the virus and blunt its curve. The model predicted far fewer deaths if lockdown measures — measures such as those taken by the British and American governments — were undertaken.
After just one day of ordered lockdowns in the U.K., Ferguson is presenting drastically downgraded estimates, crediting lockdown measures, but also revealing that far more people likely have the virus than his team figured.
Ferguson explained, “I should admit, we’ve always been sensitive in the analysis in the modeling to a variety of levels or values to those quantities. What we’ve been seeing, though, in Europe in the last week or two is a rate of growth of the epidemic which was faster than we expected from early data in China. And so we are revising our quotes, our central best estimate of the reproduction… something more, a little bit above of the order of three or a little bit above rather than about 2.5.” He added, “the current values are still within the wide range of values which modeling groups [unintelligible] we should have been looking at previously.”
A higher rate of transmission than expected means that more people have the virus than previously expected; when the number of those with coronavirus is divided by the number of deaths, therefore, the mortality rate for the disease drops.
Based on both those revised estimates and the lockdown measures taken by the British government, the epidemiologist predicts, hospitals will be just fine taking on COVID-19 patients and estimates 20,000 or far fewer people will die from the virus itself or from its agitation of other ailments, as reported by New Scientist Wednesday.
Ferguson’s change of tune comes days after Oxford epidemiologist Sunetra Gupta criticized the professor’s model.
“I am surprised that there has been such unqualified acceptance of the Imperial model,” Gupta said, according to the Financial Times.
Professor Gupta led a team of researchers at Oxford in a modeling study which suggests that the virus has been invisibly spreading for at least a month earlier than suspected, concluding that as many as half of the people in the United Kingdom have already been infected by COVID-19.
If her model is accurate, fewer than one in a thousand who’ve been infected with COVID-19 become sick enough to need hospitalization, leaving the vast majority with mild cases or free of symptoms.
Ferguson did continue to argue that the Oxford model is too optimistic about death rates.
UPDATE: Amid widespread reporting on his new death rate estimates — including by White House Coronavirus Response Coordinator Dr. Deborah Birx, who cited his 20,000 estimate during a press conference Thursday — Ferguson issued a statement on social media Thursday to “clear up confusion” about his revised estimates:
I think it would be helpful if I cleared up some confusion that has emerged in recent days. Some have interpreted my evidence to a UK parliamentary committee as indicating we have substantially revised our assessments of the potential mortality impact of COVID-19. This is not the case. Indeed, if anything, our latest estimates suggest that the virus is slightly more transmissible than we previously thought. Our lethality estimates remain unchanged. My evidence to Parliament referred to the deaths we assess might occur in the UK in the presence of the very intensive social distancing and other public health interventions now in place. Without those controls, our assessment remains that the UK would see the scale of deaths reported in our study (namely, up to approximately 500 thousand).
Correction: The original title of this article incorrectly suggested that Neil Ferguson stated his initial model was wrong. The article has been revised to make clear that he provided a downgraded projection given the new data and current mitigation steps. This article has also been updated to include Ferguson’s clarifying statement posted on Twitter on Thursday.
Epidemiologist clarifies his change in COVID-19 model
Re: Epidemiologist clarifies his change in COVID-19 model
Here is what I say to all of the "experts" who come up with these wild predictions of Dooms Day:
https://www.facebook.com/tim.cantgetrig ... g5Mjc1ODY/
Seriously, how many times does it take before we realize the media uses these "experts" to feed them new "Click Bait" FEARS each year. This one will cost the U.S. many $Trillions and many more death from the poverty that has already been created. COVID-19 won't make it to the top 10 causes of death in the U.S., but we will see a sharp increase in the number of suicides.
I talked to my older sister who works part-time in one of the largest hospitals in Chicago. She told me yesterday that about a third of their beds are empty because they cancelled all elective surgeries and sent home as many patients as they could to make room for the flood of COVID-19 victims. Chicago should be in better shape than NYC.
https://www.facebook.com/tim.cantgetrig ... g5Mjc1ODY/
Seriously, how many times does it take before we realize the media uses these "experts" to feed them new "Click Bait" FEARS each year. This one will cost the U.S. many $Trillions and many more death from the poverty that has already been created. COVID-19 won't make it to the top 10 causes of death in the U.S., but we will see a sharp increase in the number of suicides.
I talked to my older sister who works part-time in one of the largest hospitals in Chicago. She told me yesterday that about a third of their beds are empty because they cancelled all elective surgeries and sent home as many patients as they could to make room for the flood of COVID-19 victims. Chicago should be in better shape than NYC.
Dan Steffens
Energy Prospectus Group
Energy Prospectus Group
Re: Epidemiologist clarifies his change in COVID-19 model
Seriously, how many times does it take before we realize the media uses these "experts" to feed them new "Click Bait" FEARS each year. This one will cost the U.S. many $Trillions and many more death from the poverty that has already been created. COVID-19 won't make it to the top 10 causes of death in the U.S., but we will see a sharp increase in the number of suicides.
I talked to my older sister who works part-time in one of the largest hospitals in Chicago. She told me yesterday that about a third of their beds are empty because they cancelled all elective surgeries and sent home as many patients as they could to make room for the flood of COVID-19 victims.
Dan,
What does your sister do part-time in a Chicago hospital? Is she on the front lines treating COVID-19 patients seven days a week? Does she agree with you that we should just all go back to work now and let the chips fall where they may?
I don't know what experts you are referring to, but why don't you name some epidemiologists and infectious disease experts who agree with you?
As for your claim that there will be many more suicides in the U.S. as a result of the mitigation measures' effect on the economy, show us your evidence! Or is this just your repeating/exaggerating unsupported talking points you hear from the Dan Patricks of the world? In 2017 there were 47,173 suicides in the U.S. https://www.medicalnewstoday.com/articl ... 29#suicide How many suicides are health experts (as opposed to politicians and pundits) projecting will result from the economic effects of government mandated mitigation efforts? Show me the data.
"Clickbait FEARS"? YOU, my friend, are the one using unsupported and likely exaggerated claims to spread the FEAR you so readily condemn.
Your comparison of COVID-19 to the other causes of death in the USA shows you still don't understand (or you refuse to acknowledge) the basic problem. None of the top 10 (heart disease and cancer were 1 and 2 in 2017) has the ability to suddenly overwhelm our nation's healthcare system. None has the capacity to suddenly require policy makers to make stark, life-saving health care rationing decisions on a wide scale. None has the capacity to take the lives of many health care workers who unselfishly are caring for patients. COVID-19, when spreading rapidly, does all of those unless mitigation efforts slow transmission so that the infections occur over a longer span of time, to give us time to ramp production of PPE, develop effective therapies, conduct wide-scale testing, and develop a vaccine.
Your prediction that COVID-19 deaths won't make it into the top 10 in the USA might prove to be right. I hope so. But if so, it will be only because policy makers strongly disagree with your view that our mitigation efforts are foolhardy, an overreaction, the result of hysteria and fear. Their decisions to buy time while therapies are developed, PPE is manufactured, widespread testing can be done, and beds can be built, were and are overwhelmingly supported by our states' governors. I sincerely hope we can keep COVID-19 deaths below anyone's expectations, yours included.
On March 25 (when there were about 66,790 US active cases), you predicted that US active cases would peak at 100,000-120,000 by April 15 and then "go on steady decline." As I type this on March 29, US active cases are 135,135 and still climbing. The number of active cases has risen far faster than you predicted, again, reflecting a lack of understanding of the problem, buying time. Thank goodness policy makers didn't agree with you.
You still have not answered my questions about to whom life-saving health care should be denied. Who, Dan? If you or your wife were to need a ventilator to survive because we all went back to work, or we went on another cruise, are you going to say no, let someone younger than I have it? And what about the doctors, nurses and respiratory therapists who you want to be available to care for you (and every one else whom we infect) because we all go back to work and resume our normal activity before the spread is under control? Should they risk their lives (and those of their families) even more than they are now, so that the economy can be helped and we can take our next cruise sooner?
You appear to question, at this early stage, whether some hospitals outside of NY (the US is still early in this pandemic, or do you dispute that, too) are being stretched. Read carefully the below account of an ER physician in New Orleans, then tell us we should all just go back to work.
ER doctor offers lessons on treating Covid-19 patients… Cheat Sheet for Physicians (excellent read)…
Posted by Kane on March 29, 2020 1:50 am
“I am an Emergency Room MD in New Orleans, UNC class of ’98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.
Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias (back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell and taste, anorexia, fatigue.
Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.
China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.
Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.
Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.
Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.
A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.
An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes. Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.
Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won’t make it back.
We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.
Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the “lockdown”, our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.
Treatment
Worldwide 86% of covid-19 patients that go on a ventilator die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.
Plaquenil (hydroxy-chloroquine) which has weak ACE2 blockade doesn’t appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell.
With Plaquenil’s potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.
We are also using Azithromycin.
Do not give these patient’s standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.
Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.
Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.
Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.
The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn’t often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.
Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis. We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.
One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.
I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.”
I talked to my older sister who works part-time in one of the largest hospitals in Chicago. She told me yesterday that about a third of their beds are empty because they cancelled all elective surgeries and sent home as many patients as they could to make room for the flood of COVID-19 victims.
Dan,
What does your sister do part-time in a Chicago hospital? Is she on the front lines treating COVID-19 patients seven days a week? Does she agree with you that we should just all go back to work now and let the chips fall where they may?
I don't know what experts you are referring to, but why don't you name some epidemiologists and infectious disease experts who agree with you?
As for your claim that there will be many more suicides in the U.S. as a result of the mitigation measures' effect on the economy, show us your evidence! Or is this just your repeating/exaggerating unsupported talking points you hear from the Dan Patricks of the world? In 2017 there were 47,173 suicides in the U.S. https://www.medicalnewstoday.com/articl ... 29#suicide How many suicides are health experts (as opposed to politicians and pundits) projecting will result from the economic effects of government mandated mitigation efforts? Show me the data.
"Clickbait FEARS"? YOU, my friend, are the one using unsupported and likely exaggerated claims to spread the FEAR you so readily condemn.
Your comparison of COVID-19 to the other causes of death in the USA shows you still don't understand (or you refuse to acknowledge) the basic problem. None of the top 10 (heart disease and cancer were 1 and 2 in 2017) has the ability to suddenly overwhelm our nation's healthcare system. None has the capacity to suddenly require policy makers to make stark, life-saving health care rationing decisions on a wide scale. None has the capacity to take the lives of many health care workers who unselfishly are caring for patients. COVID-19, when spreading rapidly, does all of those unless mitigation efforts slow transmission so that the infections occur over a longer span of time, to give us time to ramp production of PPE, develop effective therapies, conduct wide-scale testing, and develop a vaccine.
Your prediction that COVID-19 deaths won't make it into the top 10 in the USA might prove to be right. I hope so. But if so, it will be only because policy makers strongly disagree with your view that our mitigation efforts are foolhardy, an overreaction, the result of hysteria and fear. Their decisions to buy time while therapies are developed, PPE is manufactured, widespread testing can be done, and beds can be built, were and are overwhelmingly supported by our states' governors. I sincerely hope we can keep COVID-19 deaths below anyone's expectations, yours included.
On March 25 (when there were about 66,790 US active cases), you predicted that US active cases would peak at 100,000-120,000 by April 15 and then "go on steady decline." As I type this on March 29, US active cases are 135,135 and still climbing. The number of active cases has risen far faster than you predicted, again, reflecting a lack of understanding of the problem, buying time. Thank goodness policy makers didn't agree with you.
You still have not answered my questions about to whom life-saving health care should be denied. Who, Dan? If you or your wife were to need a ventilator to survive because we all went back to work, or we went on another cruise, are you going to say no, let someone younger than I have it? And what about the doctors, nurses and respiratory therapists who you want to be available to care for you (and every one else whom we infect) because we all go back to work and resume our normal activity before the spread is under control? Should they risk their lives (and those of their families) even more than they are now, so that the economy can be helped and we can take our next cruise sooner?
You appear to question, at this early stage, whether some hospitals outside of NY (the US is still early in this pandemic, or do you dispute that, too) are being stretched. Read carefully the below account of an ER physician in New Orleans, then tell us we should all just go back to work.
ER doctor offers lessons on treating Covid-19 patients… Cheat Sheet for Physicians (excellent read)…
Posted by Kane on March 29, 2020 1:50 am
“I am an Emergency Room MD in New Orleans, UNC class of ’98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.
Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias (back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell and taste, anorexia, fatigue.
Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.
China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.
Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.
Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.
Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.
A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.
An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes. Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.
Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won’t make it back.
We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.
Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the “lockdown”, our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.
Treatment
Worldwide 86% of covid-19 patients that go on a ventilator die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.
Plaquenil (hydroxy-chloroquine) which has weak ACE2 blockade doesn’t appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell.
With Plaquenil’s potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.
We are also using Azithromycin.
Do not give these patient’s standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.
Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.
Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.
Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.
The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn’t often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.
Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis. We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.
One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.
I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.”